School of Pediatrics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
Doctors with Africa CUAMM, Iringa, Tanzania.
BMC Pregnancy Childbirth. 2024 Oct 10;24(1):660. doi: 10.1186/s12884-024-06837-w.
Worldwide about 2.3 million newborns still die in the neonatal period and the majority occurs in low- and middle-income countries (LMICs). Intrapartum-related events account for 24% of neonatal mortality. Of these events, intrapartum birth asphyxia with subsequent neonatal encephalopathy is the main cause of child disabilities in LMICs. Data on neurodevelopmental outcome and early risk factors are still missing in LMICs. This study aimed at investigating the factors associated with mortality, risk of neurodevelopmental impairment and adherence to follow-up among asphyxiated newborns in rural Tanzania.
This retrospective observational cohort study investigated mortality, neurodevelopmental risk and adherence to follow-up among asphyxiated newborns who were admitted to Tosamaganga Hospital (Tanzania) from January 2019 to June 2022. Neurodevelopmental impairment was assessed using standardized Hammersmith neurologic examination. Admission criteria were Apgar score < 7 at 5 min of life and birth weight > 1500 g. Babies with clinically visible congenital malformations were excluded. Comparisons between groups were performed using the Mann-Whitney test, the Chi-square test, and the Fisher test.
Mortality was 19.1% (57/298 newborns) and was associated with outborn (p < 0.0001), age at admission (p = 0.02), lower Apgar score at 5 min (p = 0.003), convulsions (p < 0.0001) and intravenous fluids (IV) (p = 0.003). Most patients (85.6%) were lost to follow-up after a median of 1 visit (IQR 0-2). Low adherence to follow-up was associated with female sex (p = 0.005). The risk of neurodevelopmental impairment at the last visit was associated with longer travel time between household and hospital (p = 0.03), female sex (p = 0.04), convulsions (p = 0.007), respiratory distress (p = 0.01), administration of IV fluids (p = 0.04), prolonged oxygen therapy (p = 0.004), prolonged hospital stay (p = 0.0007) and inappropriate growth during follow-up (p = 0.0002).
Our findings demonstrated that mortality among asphyxiated newborns in a rural hospital in Tanzania remains high. Additionally, distance from home to hospital and sex of the newborn correlated to higher risks of neurodevelopmental impairment. Educational interventions among the population about the importance of regular health assessment are needed to improve adherence to follow-up and for preventive purposes. Future studies should investigate the role of factors affecting the adherence to follow-up.
全世界仍有 230 万新生儿在新生儿期死亡，其中大多数发生在中低收入国家（LMICs）。与分娩过程相关的事件占新生儿死亡的 24%。在这些事件中，分娩时窒息导致的新生儿脑病是 LMICs 儿童残疾的主要原因。关于神经发育结局和早期危险因素的数据在 LMICs 中仍然缺失。本研究旨在调查坦桑尼亚农村窒息新生儿的死亡率、神经发育损伤风险和随访依从性的相关因素。
本回顾性观察队列研究调查了 2019 年 1 月至 2022 年 6 月期间因窒息而被收治于 Tosamaganga 医院（坦桑尼亚）的窒息新生儿的死亡率、神经发育风险和随访依从性。使用标准化的哈默史密斯神经检查评估神经发育损伤。纳入标准为出生后 5 分钟时 Apgar 评分<7 和出生体重>1500g。排除有临床可见先天性畸形的婴儿。使用 Mann-Whitney 检验、卡方检验和 Fisher 检验比较组间差异。
死亡率为 19.1%（298 名新生儿中的 57 名），与外源性分娩（p<0.0001）、入院时年龄（p=0.02）、出生后 5 分钟 Apgar 评分较低（p=0.003）、抽搐（p<0.0001）和静脉输液（IV）（p=0.003）有关。大多数患者（85.6%）在中位数为 1 次就诊后失访（IQR 0-2）。随访依从性低与女性性别（p=0.005）有关。末次随访时神经发育损伤的风险与家庭和医院之间的旅行时间较长（p=0.03）、女性性别（p=0.04）、抽搐（p=0.007）、呼吸窘迫（p=0.01）、IV 输液（p=0.04）、长时间吸氧（p=0.004）、长时间住院（p=0.0007）和随访期间生长不当（p=0.0002）有关。
我们的研究结果表明，坦桑尼亚农村医院窒息新生儿的死亡率仍然很高。此外，家庭与医院之间的距离和新生儿的性别与神经发育损伤的高风险相关。需要对人群进行有关定期健康评估重要性的教育干预，以提高随访依从性和预防目的。未来的研究应调查影响随访依从性的因素的作用。
